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Background Vaccination requirements for kindergarten entry vary by state, but all states require 2 doses of measles containing vaccine (MCV) at kindergarten entry. Objective To assess (i) national MCV vaccination coverage for children who had attended kindergarten; (ii) the extent to which undervaccination after kindergarten entry is attributable to parents’ requests for an exemption; (iii) the extent to which undervaccinated children had missed opportunities to be administered missing vaccine doses among children whose parent did not request an exemption; and (iv) the vaccination coverage gap between the “highest achievable” MCV coverage and actual MCV coverage among children who had attended kindergarten. Methods A national survey of 1465 parents of 5–7 year-old children was conducted during October 2013 through March 2014. Vaccination coverage estimates are based provider-reported vaccination histories. Children have a “missed opportunity” for MCV if they were not up-to-date and if there were dates on which other vaccines were administered but not MCV. The “highest achievable” MCV vaccination coverage rate is 100% minus the sum of the percentages of (i) undervaccinated children with parents who requested an exemption; and (ii) undervaccinated children with parents who did not request an exemption and whose vaccination statuses were assessed during a kindergarten grace period or period when they were provisionally enrolled in kindergarten. Results Among all children undervaccinated for MCV, 2.7% were attributable to having a parent who requested an exemption. Among children who were undervaccinated for MCV and whose parent did not request an exemption, 41.6% had a missed opportunity for MCV. The highest achievable MCV coverage was 98.6%, actual MCV coverage was 90.9%, and the kindergarten vaccination gap was 7.7%. Conclusion Vaccination coverage may be increased by schools fully implementing state kindergarten vaccination laws, and by providers assessing children’s vaccination status at every clinic visit, and administering missed vaccine doses. [ABSTRACT FROM AUTHOR]

The ambitious objective pursued by the European Water Framework Directive (WFD) is good status for all European waters. However, “less stringent environmental objectives” are permissible if the costs of achieving good status are disproportionately high. This exemption, if abused, carries the risk of watering down the ambitions of the Directive. Currently, no transparent, well-established, universally applicable method for routinely testing disproportionality exists throughout Europe. In this paper, such a method is developed for surface water bodies. The core idea is to determine a water body-specific disproportionality threshold which is then compared to the projected costs of achieving “good status/potential”. For the sake of practicability, the benchmark for disproportionality is estimated on the basis of prior expenditure on water quality enhancement. The paper argues that the proposed method combines both possible interpretations of (dis-)proportionality—affordability and cost-benefit considerations. Due to the method’s moderate data requirements it can be used readily in most German federal states and is transferable in principle to other EU Member States. The method was tested empirically for a river in the German federal state of Rhineland–Palatinate. [ABSTRACT FROM AUTHOR]

Background and objectives School immunization requirements have ensured high vaccination rates and have helped to control vaccine-preventable diseases. However, vaccine exemptions have increased in the last decade. This study compared New York State private versus public schools with respect to medical and religious exemption rates. Methods This retrospective study utilizes New York State Department of Health Immunization Survey data from the 2003 through 2012 academic years. Schools were categorized as private or public, the former further categorized by religious affiliation. Rates of medical and religious vaccine exemptions were compared by school category. Results From 2003 to 2012, religious exemptions increased in private and public schools from 0.63% to 1.35% and 0.17% to 0.29% (Spearman's R : 0.89 and 0.81), respectively. Among private schools, increases in religious exemption rates during the study period were observed in Catholic/Eastern Orthodox, Protestant/Other Christian, Jewish, and secular schools (Spearman's R = 0.66, 0.99, 0.89, and 0.93), respectively. Exemption rate ratios in private schools compared to public schools were 1.39 (95% CI 1.15–1.68) for medical and 3.94 (95% CI: 3.20–4.86) for religious exemptions. Among private school students, all school types except for Catholic/Eastern Orthodox and Episcopal affiliates were more likely to report religious exemptions compared to children in public schools. Conclusions Medical and religious exemption rates increased over time and higher rates were observed among New York State private schools compared to public schools. Low exemption rates are critical to minimize disease outbreaks in the schools and their community. [ABSTRACT FROM AUTHOR]

For the civil aircraft type certification, exemptions from the requirements of specified airworthiness standards are always requested by the Type Certificate applicants. The paper describes the airworthiness provision and related procedures of Civil Aviation Administration of China (CAAC) for the approval of exemptions, as well as its unique features compared with those of other main airworthiness authorities. The CAAC civil aviation regulation for a temporary or permanent exemption is firstly introduced. Based on the assignment of responsibilities of the authority, a step by step exemption management flow is demonstrated. In accordance with it, the detailed tasks should be implemented by the applicant and the authority in the process of the exemption petition, evaluation, and proposal for public comments, review and approval are illustrated, especially on the exemption approval considerations. The major differences between the exemption process of CAAC and other main airworthiness authorities are preliminarily proposed. [ABSTRACT FROM AUTHOR]

Highlights: [•] We describe school officials' knowledge of California's new immunization exemption law. [•] We find an overall low level of awareness and knowledge about the new legislation. [•] Respondents from high-exemption schools show higher specific knowledge of AB-2109. [•] Support staff show lower knowledge compared to health or administrative staff. [•] Schools need additional information, training and template materials for implementation. [ABSTRACT FROM AUTHOR]

Highlights: [•] Personal belief exemption rates in CA schools rose by 9.2%/year over 1994–2009, from 0.6% in 1994 to 2.3% in 2009. [•] Exemption rates increased faster among private schools than public schools. [•] Schools in rural areas had higher exemption rates than schools in urban areas. [•] Community-level demographics were associated with exemption rates. [ABSTRACT FROM AUTHOR]

With an estimated $1.5 billion in potential stimulus bonus payments for radiologist professionals at stake, and penalties looming farther down the road, radiologists would be wise to study and respond to recent federal regulations related to meaningful use of complete certified ambulatory electronic health records and their equivalents. Many radiologists mistakenly believe that they were “left out” of the meaningful use rewards or that compliance is technically impractical. With diligent preparation, including the adoption of new technology and workflows, the vast majority of radiologists can qualify before October 2012 to capture the full available rewards and avoid later penalties. [Copyright &y& Elsevier]

Abstract: Isotope-specific exemption levels for surface contamination are calculated for representative radionuclides in general nuclear power plants by developing a deterministic dose assessment model for surface contamination that can be applied to radiation, transport and waste safety, and a practical idea of judging exemption for gross surface contamination by measuring gross gamma-ray emission has been proposed. In the dose assessment model, the objects with surface contamination are classified into three types: manually handled, closely handled and remotely handled objects, and the exemption criteria are chosen to be 0.01mSv/yr in the case of using realistic exposure parameters and 1mSv/yr in the case of using low-probability exposure parameters in accordance with the IAEA Safety Standards Series No. RS-G-1.7. Taking into account the distribution area of surface contamination assumed in the dose assessment model, instead of using the evaluation area of 100cm2 without variation, the exemption levels for gross surface contamination are found to be higher than those obtained by the conventional method for some radionuclides such as Mn-54, Co-60, Zn-65, Nb-94, Cs-134, Cs-137, Eu-152 and Eu-154. [Copyright &y& Elsevier]

We consider the problem of distributing the liquidation value of a bankrupt firm among its creditors. Herrero and Villar [TOP 10 (2002) 261; Mathematical Social Sciences 42 (2001) 307] show that (i) the constrained equal awards rule is the only rule satisfying sustainability and composition down, and that (ii) it is the only rule satisfying exemption, composition down, and bilateral consistency. This note has three results. First, we give a direct and elementary proof of (i). Second, we connect (i) and (ii) by means of the Elevator Lemma, which is introduced by Thomson [Mimeo, University of Rochester, 2000]. Third, by exploiting the Elevator Lemma, we show that the constrained equal awards rule is the only rule satisfying exemption, composition down, and converse consistency. Thus, (ii) can be obtained as a corollary of our new characterization of the rule. [Copyright &y& Elsevier]

In recent years, forcible displacement has increased around the globe, with significant numbers of people seeking shelter in urban areas. However, increased densification has added pressure to housing in these urban host communities, creating a situation where temporary accommodation is not always readily available. The integration of humanitarian response and pre-existing sustainable development activities is necessary to avoid disruptions to the provision of infrastructure services. This humanitarian-development nexus (HD-nexus) has proven to be difficult to operationalize. Using the experience of Sweden in 2015, this study looks at the provision of temporary accommodation for asylum-seekers within the existing regulatory framework as a place to explore the HD-nexus. Results show that humanitarian actors justify circumventing government institutions to achieve short-term response while development activities operate within these same institutions. Regulatory exemptions are one pathway by which we can observe this fundamental difference between the two approaches. Interviews with 19 individuals from government agencies, nonprofit organizations, and private companies were qualitatively analyzed to relate legitimacy with humanitarian response and development logics in the context of providing temporary accommodation. Results show that although formal regulatory definitions of temporary for temporary accommodations exist, this is not always adopted by stakeholders, leading to regulatory exemptions and non-compliance. Findings support decision-makers in improving response time and coordination for future events, and development goals of sustainable urban development. [ABSTRACT FROM AUTHOR]

The launch of the Millennium Development Goals in 2000, followed by the Sustainable Development Goals in 2015, and the increasing focus on achieving universal health coverage has led to numerous interventions on both supply- and demand-sides of health systems in low- and middle-income countries. While tremendous progress has been achieved, inequities in access to healthcare persist, leading to calls for a closer examination of the equity implications of these interventions. This paper examines the equity implications of two such interventions in the context of maternal healthcare in Senegal. The first intervention on the supply-side focuses on improving the availability of maternal health services while the second intervention, on the demand-side, abolished user fees for facility deliveries. Using three rounds of Demographic Health Surveys covering the period 1992 to 2010 and employing three measures of socioeconomic status (SES) based on household wealth, mothers' education and rural/urban residence – we find that although both interventions increase utilisation of maternal health services, the rich benefit more from the supply-side intervention, thereby increasing inequity, while those living in poverty benefit more from the demand-side intervention i.e. reducing inequity. Both interventions positively influence facility deliveries in rural areas although the increase in facility deliveries after the demand-side intervention is more than the increase after the supply-side intervention. There is no significant difference in utilisation based on mothers' education. Since people from different SES categories are likely to respond differently to interventions on the supply- and demand-side of the health system, policymakers involved in the design of health programmes should pay closer attention to concerns of inequity and elite capture that may unintentionally result from these interventions. • We study equity implications of demand- and supply-side interventions in the context of maternal healthcare in Senegal. • People from different socioeconomic groups respond differently to supply and demand-side interventions. • The supply-side intervention benefitted the richer households more, thereby increasing inequity. • The demand-side intervention benefitted the poorer households more, thereby reducing inequity. • Policymakers should pay closer attention to concerns of inequity that may unintentionally result from these interventions. [ABSTRACT FROM AUTHOR]

The Ballast Water Management Convention (BWMC) entered into force in September 2017. Most countries have enacted relevant national laws and regulations to mitigate the hazards of ballast water-mediated introductions of non-indigenous aquatic species (NIS). Taiwan's critical location as an important transportation hub in the Western Pacific Ocean makes it a hot spot for such invasions. For the past few years, policy dialogue between government and the shipping sector has been actively continuously conducted in order to form a consensus for devising strategies for the management of ballast water. In this study, information on policy debates among multiple stakeholders for three consecutive years and vessel traffic information were utilized to explore policy options for ballast water management. This article provides several recommendations for the implementation of the Convention in the early stages, including a three-tiered port state control (PSC) system, designation of an alternative ballast water exchange zone, and possibility of exemption. [ABSTRACT FROM AUTHOR]

Abstract: Using a probabilistic approach, the influence of dose distribution after the dose distribution due to artificial nuclides is added to that for NORM has been studied. On the basis of such an approach, the dose criteria of the order of 0.01 mSv/year for exemption and clearance could be set higher, for example, to the order of 0.1 mSv/year. [Copyright &y& Elsevier]